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Claims Specialist

2 months ago

Santa Barbara, United States Radiocw-Healthcare Full time

**Job Title: Claims Processor**

**Location: 540 W. Pueblo Street, Santa Barbara, CA 93105**

**Shift: 08:00 AM - 17:00 PM**

**Contract Duration: 13**

**Job Summary**:
**SUMMARY**:
This job operates in a professional office environment. Some patient care environment with potential exposure to unpleasant odors, communicable diseases, electrical hazards and other conditions common to a clinic environment. Climate controlled, indoor environment. Occasional exposure to outdoor climate. Work may be stressful at times.

**DUTIES & ESSENTIAL JOB FUNCTIONS**:

- Performs a spectrum of clerical chores that culminate in determinations for payment of claims to providers for authorized services rendered; specifically for HMO patients, encounter claims from PCP’s or capitated specialists, ancillary claims, emergency room, shared risk, anesthesia, eye exams claims, and Clinic specialty claims.
- Adheres to HIPAA regulations.
- Attends required meetings and participates in committees as requested.
- Participates in department quality improvement, clinic safety, infection control and hazardous materials programs/activities.
- Completes annual performance and competency evaluation process with management and participates in goal setting, performance improvement and educational training as needed.
- Adheres to all policies and procedures.
- Maintains certification and license requirements and submits required evidence of certification/licensure as needed.
- Maintains and evaluates own clinical expertise and practice. Recognizes legal and policy limits of individual practice.
- Adheres to established safety requirements and procedures to ensure a safe working environment.
- Demonstrates sound cost containment techniques.
- Provides exemplary customer service to patients and staff.
- Maintains the strictest confidentiality in accordance with Sansum Clinic policy.
- This position has a direct influence upon both the financial condition of the organization and its’ reputation as a TPA (Third Party Administrator).
- In addition, answers inquiries from patients, providers and HMO’s regarding status of claims, general payment, benefit, eligibility, and referrals.
- The processing involves making reasoned determinations as to eligibility for benefits, authorization of services rendered, financial responsibility for the costs incurred, verification of payment-amounts based on contractual agreements with providers, and fulfillment of co-payments or shared risk payments.
- Performs related work as required.

**MINIMUM QUALIFICATIONS**:

- High School diploma or equivalent; some secondary (college) education desirable.
- 1+ Year of experience in medical claims processing or insurance billing in a medical capacity.
- COVID Vaccination
- Epic Experience (preferred)

**Job Type**: Contract

Pay: $24.00 per hour

Expected hours: 40 per week

Work setting:

- In-person

**Experience**:

- Claim processing: 1 year (required)
- Epic: 1 year (required)

Ability to Commute:

- Santa Barbara, CA 93105 (required)

Work Location: In person